Clomipramine Galactorrhoea and amenorrhoea

Clomipramine 75mg bid, l-tryptophan 1 g tid and a course 01 6 episodes of electroconvulsive therapy (ECT) were prescribed tor a woman in her late twenties with depression. After 2 days' drug treatment (and 1 day after the first episode of ECT), the woman presented with profuse lactation and amenorrhoea. A biochemical examination showed serum prolactin concentration 3372 Uuj ml , and serum clomipramine and desmethylclomipramine concentrations of 50 Ug/L and 170 Ug/L. respectively.

The patient's symptoms did not resolve on withdrawal of L-tryptophan and ECT. Thus , the clomipramine dose was gradually reduced to 25mg bid and the dopamine agonist 2-bromo-Q"­ergocryptine administered at a dose of 2.5mg bid for 1 week and 2.5 mg/day thereafter.

At 6 weeks, the galactorrhoea and amenorrhoea had resolved and serum concentrations of prolactin , clomipramine and desmethylclomipramine were 126 Uu/ml , 30 Ug/l and 65 Ug/L, respectively . Thus, ' ... the introduction of clomipramine appeared to be the specific factor which precipitated inappropriate and profuse lactation, with secondary amenorrhoea'. Anand. V.S. anflsh Journal 01 Psychia1ry 147' 87· 88 (Jul 1985)